原发性硬化性胆管炎诊治的探讨

文章报导该院自1986～1995年收治的原发性硬化性胆管炎20例，其中男性16例，女性4例，平均年龄44岁。从出现症状至确诊平均病程2年，阻塞性黄疸是该组病人的突出表现。诊断主要依靠直接胆道造影，如胆管纤细，枯树枝状，串珠状，剪枝状或跳跃节段状，水中胆道病理检查可以与胆管癌鉴别。硬化性胆管炎应该早期治疗，主要手术方式是胆管空肠Rouxy吻合加肝内胆管U管引流，胆管的支撑管应停留1年以上。本病最终会引起胆汁性肝硬化，终末期可选择肝移植。

THE DIAGNOSIS AND TREATMENT OF PRIMARY SCLEROSING CHOLANGITIS

Twenty cases of primary sclerosing cholangitis admitted into the hospital between 1986 and 1995 are reported in this article. The series consisted of 16 males and four females, mean age of 44 years. The average collrse of the disease before making a deflnite diagnosis was about two ycars, and obstructive jaundice was the predominant manifestation. Diagnosis was based mainly on direct cholangiography, whlch showed threadllke narrowing or irregularities and tortuosity of the ducts, and sometimcs showed beaded appearance, pruned tree appearance, or skip dilatation of the ducts. Biopsy of the bile ducts over operation could diffcrcntiate the diseasc from carcinoma of the ducts.Treatment must be inltiated immedlately after definite diagnosis in order to achieve e a posltive outcome. The main method of treatment is the Roux-y cholangiojeiunostomy and intrahepatic U-tube drainage, for which the biliary stent must he reservcd for at least onc year. This discase gencrally leads to biliary cirrhosis. For the final stage cases,livcr transplantation is the most effeclivc treatment option.